| Lifetime maximum | Unlimited |
| Annual maximum | Unlimited |
| Co-insurance in network | 70% |
| Co-insurance out-of-network | 50% |
| Deductible in student health center | $0 |
| Deductible in network | $900 |
| Deductible in non-network | $1,500 |
| Out of pocket in network | $8,500 |
| Co-pay in ER (waived if admitted) | $250 |
| Co-pay in SHC | $0 |
| Co-pay specialist visit | $30 |
| Pre-existing condition waiting period | No Waiting |
| Preventative care | 100%(inNetwork) |
| Medical evacuation | $100,000 |
| Repatriation | $50,000 |